高压氧联合超声清创术对糖尿病足溃疡创面细菌清除及微循环的影响

Effect of hyperbaric oxygen combined with ultrasonic debridement on bacterial clearance and microcirculation of diabetic foot ulcer wound

目的探讨超声清创术联合高压氧对糖尿病足溃疡创面细菌清除及微循环的影响。方法选取2017年1月至2020年1月龙口市人民医院血管外科收治的采取保守治疗的糖尿病足溃疡患者98例作为研究对象,按照治疗方法分为3组,A组32例,采用标准治疗;B组30例,采用标准治疗+高压氧治疗;C组36例,标准治疗+超声清创术+高压氧治疗。第0、7、14、21天采用毫米(mm)方格纸法计算溃疡创面面积的变化,并计算创面愈合率。采用表面细菌定量培养法计算溃疡创面细菌清除率。多普勒激光血流灌注成像仪测定溃疡创面微循环状况。采用肢体疼痛评分和间歇性跛行评分法评价治疗前后肢体疼痛水平。结果治疗3个疗程后,3组患者经皮氧分压和创面血流量明显高于治疗前,且C组患者治疗后经皮氧分压和创面血流量显著高于A、B组,差异均有统计学意义(P<0.05)。治疗14、21 d后,C组患者溃疡面积均明显小于A、B组,而C组溃疡愈合率明显高于A、B组,差异均有统计学意义(P<0.05)。治疗7、14、21 d后,C组患者溃疡组织内细菌定量均明显低于A、B组,差异均有统计学意义(P<0.05)。治疗3个疗程后,3组患者间歇性跛行和肢体疼痛评分明显低于治疗前,且C组患者治疗后肢体疼痛和间歇性跛行评分显著低于A、B组,差异均有统计学意义(P<0.05)。结论高压氧联合超声清创术能较好的清除糖尿病足溃疡创面细菌,促进微循环,有利于溃疡创面愈合,值得临床推广应用。

Objective To investigate the effect of ultrasonic debridement combined with hyperbaric oxygen on bacterial clearance and microcirculation of diabetic foot ulcer wound.Methods A total of 98 patients with diabetic foot ulcer who received conservative treatment in the Department of Vascular Surgery of Longkou People Hospital were selected as the research subjects and divided into three groups.The Group A(32 cases)received standard treatment;the Group B(30 cases)received standard treatment+hyperbaric oxygen therapy;the Group C(36 cases)received standard treatment+ultrasonic debridement+hyperbaric oxygen therapy.On the day 0,7,14,and 21,the changes of wound area were calculated by millimeter graph paper method,and the ulcer healing rates were also calculated.The bacterial clearance rates of ulcer wound were calculated by quantitative bacterial wound culture method.The microcirculation of ulcer wound was measured by Laser Doppler Perfusion Imaging(LDPI).The limb pains before and after treatment were evaluated by limb pain score and intermittent claudication score.Results After 3 courses of treatment,the transcutaneous oxygen partial pressures and the wound blood flows of the 3 groups were significantly higher than those before treatment,and the percutaneous oxygen partial pressure and wound blood flow of the Group C after treatment were significantly higher than those of the Group A and the Group B,with statistically significant differences(P<0.05).On the 14th and 21st day after treatment,the ulcer areas of the Group C were significantly lower than those of the Group A and the Group B,and the ulcer healing rate of Group C was significantly higher than those of the Group A and the Group B,with statistically significant differences(P<0.05).On the 7th,14th,and 21st day after treatment,the bacterial quantity in the ulcer tissue of the Group C was significantly lower than those in the Group A and the Group B(P<0.05).After 3 courses of treatment,the scores of intermittent claudication and limb pain in the three groups were significantly lower than those before treatment,and the scores of limb pain and intermittent claudication in the Group C were significantly lower than those in the Group A and the Group B after treatment(P<0.05).Conclusion Hyperbaric oxygen combined with ultrasonic debridement can effectively remove bacteria in diabetic foot ulcer wound,promote microcirculation,and help ulcer wound healing.It is worthy of clinical application.